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The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

Bad news brains: Sophie's brainstem tumor and its aftermath (so far)

by Dr. Patty Khuly

OK, so I’ve finally decided it’s time to give you an update on Sophie Sue’s story (reference my ten year-old French bulldog’s confounding condition of the past few weeks’ duration).

After playing an unrewarding game of surgical hide and seek, we found no insulinoma (or other abdominal tumor) to explain Sophie’s low blood sugar and drunken gait. Nonetheless, Sophie continued to decline—precipitously. In fact, four days after surgery Sophie was almost 100% immobile.

By then, it was clear that her condition was neurological. Low blood sugar-related dizziness was no longer at the top of our list now that she was experiencing episodic tremors that gave her ears an intermittent, Parkinsonian flair. She was so weak that even taking food into her mouth became a momentous task.

I’d already made an appointment to see the neurologist (Dr. Cook at Cooper City’s Animal Medical Center) but it wouldn’t be until the following Tuesday (he and his group were at the ACVIM conference in San Antonio). Here we were, Friday night and things had declined so far that I had no choice but to start administering Prednisone at a high dose.

So you know, I was holding off on this medication not for its frequent side effects but because it would likely mask some of the findings we’d need to achieve a proper diagnosis.

She had improved throughout the weekend but was still in pretty rough shape by Tuesday’s visit. She was scheduled for an MRI (usually the best tool to image brain problems), so I’d left her in their capable hands while she underwent the necessary anesthetic and imaging procedure.

Two hours later we had our answer: the brainstem mass the post’s title references. Here’s a picture of what it looks like on the MRI:

It’s not so sinister looking on the picture, but in person it’s a monster. I don’t think I’ve ever hated a few hundred thousand cells any more than I do those.

So now the next step…and here’s where I stress…should I irradiate them like most neurologists would recommend as the “safest,” “surest” path, or should I have ‘em cut it out using the so-called gamma knife?

Both are comparably priced, but the former requires 18 anesthetic visits over six weeks (three times per week). The other takes one trip but its outcome is less assured—it might make things MUCH better or MUCH worse. The same is true for radiation but this method’s outcomes are far more studied than the gamma knife’s (in dogs, at least).

I’ve spent the last two weeks calling neurologists all over the country, researching the different methods, even looking into some more experimental approaches. Though it took quite a bit to get some of these docs to call me back, The University of Pennsylvania’s Dr. Chick Weisse (a contemporary of mine in vet school) made himself extra-accessible and pressed Sophie’s case on his neuro and radiology team. A BIG thank you to him.

In the end, though, I’ve decided in favor of the local radiology/neurology/oncology team’s gamma knife. I don’t have the resources for a big trip to Philly, nor am I comfortable with 18 anesthetic events (not to mention the financial havoc it’ll wreak with my schedule since the hospital is so far away).

The good news is that Sophie’s feeling much better. She has a spring in her step and an appetite to match. I’ve been able to decrease her Pred dose (12 days after initiating it) and we have some time to prepare for the scary stuff.

So where are we now in the process? As usual, waiting for a specialist to call…to discuss the final issues before we can schedule things. Wish us luck. And thanks to all of you who asked about Sophie's well-being.